Category Archives: Uncategorised

Case 140: Update 4

We now have a report on the bone marrow. Immunophenotype:Lambda restricted B cell population = 8.9% of total nucleated cells.CD19+, CD5 negative, FMC7 variable (+/neg), CD23 variable (neg/+), CD200 variable (weak/neg),CD20+, CD22+, CD103 negative, CD10 negative, CD45+, CD79b weak, CD38 … Continue reading

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Case 140: Update 3

This lady has been diagnosed with CHAD and we are trying to establish whether it is primary or secondary. Her viral serology and auto-immune screen are unremarkable. Given her full blood count and splenomegaly, you are concerned about an underlying … Continue reading

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Case 140: Update 2

This lady’s blood film shows red cell agglutination at room temperature which resolves with samplewarming to 37 degrees Celsius. There is also polychromasia with spherocytosis. Herthrombocytopenia is mild but genuine with no platelets clumps. You suspect this lady has haemolytic … Continue reading

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Case 140: Update 1

This lady has a new macrocytic anaemia and is symptomatic. She is also mildly thrombocytopenic. Her B12 and folate are normal, unfortunately the rest of her biochemistry has haemolysed. Her reticulocyte count is raised at 188 ×109/L. She has no … Continue reading

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Case 140: The beginning

You are the on call haematologist and are asked by one of the secretaries to speak to a worried GPon the phone. It is regarding a 52 year old lady who saw her GP with a 2 week history of … Continue reading

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Case 139 – Summary

The cases this week were designed to consider the complexities of VTE management in cancer patients.  VTE is four to seven times as common in the cancer population compared to the general population. Cancer associated thrombosis is the second commonest … Continue reading

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Case 139 – short case 2 update 2

Thanks for your input with regards to IVC filter decision making. You ask a few more questions and establish that the patient has declined any further investigation for her likely metatataic malignancy and the oncology team advise her prognosis is … Continue reading

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Case 139 – short case 2

You are the haematologist on call and phoned at 5pm on a Friday about a 75 year old lady who presented to the acute admissions unit with confusion. She was diagnosed with Hypercalcaemia and a subsequent CT is suggestive of … Continue reading

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Case 139 – short case 1 update 3

After careful consideration you opted for weight based LMWH due to concerns about Thrombocytopenia and he has a bladder cancer with history of haematuria. A month later his platelet count has recovered but he has developed new dyspnoea. He is … Continue reading

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Case 139 – short case 1 update 2

The decision was made not to give thromboprophylaxis in the poll. As previously provoked DVT and also history of ongoing bleeding and iron deficiency with risk of thrombocytopenia on the chemotherapy. His Khorana score was 1 (Intermediate risk 1.8-2% chance … Continue reading

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Case 139 – short case update 1

You establish the patient apart from his new cancer diagnosis and previous DVT is usually well. BMI 30. His full blood count is normal apart from microcytic anemia Hb 101, MCV 77, plt 300, Wcc 9. He has been having … Continue reading

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Case 139 – the beginning of short case 1

This week we are going to have two short cases to discuss the tricky management of cancer associated VTE. It would be great to hear your thoughts and suggestions as like so much of practice there are likely several approaches … Continue reading

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Case series 138 – Summary

This week, we covered a series of cases in various clinical settings with patients presenting with very high white cell counts (>50 x 109 / L). The differential diagnosis is wide, including both haematological (hyperleukocytosis) and non-haematological (leukemoid reactions) causes. … Continue reading

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Case series 138 – part 3

You are a GP registrar working in primary care. It’s 5 pm on Friday and you are going through the last few blood results before the weekend. The final patient is a normally fit and well 69 year old man … Continue reading

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Case series 138 – part 2

You are the critical care registrar on call and get called to A+E to review a 65 year old patient in resus. The patient is in extremis with sats of 88% on 15 L non-rebreath mask and is septic with … Continue reading

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Case series 138 – Part 1

You are the surgical SHO on call and get called by A+E to see a 23 year old patient with severe abdominal pain. The patient is septic and being treated with broad spectrum antibiotics and fluid resuscitation. Examination demonstrates severe … Continue reading

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Case 137 – Summary

Thank you for your help in the management of our 53 year old man who presented with all of the CRAB constellation of symptoms of multiple myeloma (hypercalcaemia, renal impairment, anaemia and lytic bone lesions). We talked a bit about … Continue reading

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case 137 – Update 5

It is now nearly 3 years since our patient completed his treatment for myeloma and you noticed that he had started to become a little anaemic with Hb 97, neuts 1.9 and plts 120. You asked for more information. Film … Continue reading

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Case 137 – Update 4

Thanks for all your help with management of this chap. We have confirmed his diagnosis of multiple myeloma on bone marrow biopsy and completed imaging with plain films of his long bones as he has already had a whole spine … Continue reading

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Case 137 – Update 3

You have undertaken a bone marrow biopsy and the aspirate (shown below) and flow are back. There is a population of abnormal CD20+, CD38+, CD138+, CD56+ cells. Cytogenetics awaited His calcium is a little better at 3.1 but his renal … Continue reading

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